Following over 100 million cases and millions of deaths worldwide, vaccinations are underway worldwide, with nations like Israel and the UAE leading the way. Experts have forecasted that life may return to some semblance of normalcy in the latter half of 2021, giving the global community a chance to rebuild from the damages caused by the virus.
While many major countries seem to be celebrating the beginning of the end, other less developed nations are struggling to secure doses of the vaccine and develop efficient distribution plans. Many of these states may not even see vaccination for several months or years, and nowhere can this tragic inequality be better observed than in sub-Saharan Africa. In short, Sub-Saharan Africa is currently at risk of suffering a widespread vaccine shortage and delivery crisis, which will cause COVID-19 to linger and mutate in the region with inevitable adverse impacts on pandemic recovery efforts worldwide.
For much of the pandemic, Sub-Saharan Africa has largely been an under-discussed case of effective countermeasures against the virus, with nations like Rwanda, Liberia and more successfully mitigating the virus' effects despite limited public health resources. These nations have shown remarkable ingenuity and adaptivity in controlling the spread of infection. For example, Sierra Leona's unique organizational tactics allowed them to better conserve resources and contain the virus and Senegal's unique COVID-19 emergency command center helped them coordinate that country's viral response.
But lockdowns and precautions cannot contain COVID-19 forever, which is why the vaccine is so critical. Unfortunately, Sub-Saharan Africa is at risk of a shortage. It needs around 1.5 billion doses to achieve a low base herd immunity threshold of 60 percent, which is what is required in order to limit viral spread and eliminate COVID-19 from the population. The second wave of cases currently hitting the region will likely further increase both these case counts and the need for widespread vaccination.
Despite the critical need, Sub-Saharan Africa has only reserved a mere fraction of the number of vaccines needed to achieve herd immunity. This shortage is mainly due to high-income countries having successfully outbid low-income states, securing 51 percent of the global vaccine supply, despite making up only about 14 percent of the global population. As a result, most estimates suggest that only 20 percent of Sub-Saharan Africa will receive the vaccine by the end of 2021.
Even if these states can effectively acquire enough doses, a separate problem almost immediately emerges: distribution. Getting the vaccines across the entirety of the continent will be an immense hurdle, especially given the cold storage systems required by the Pfizer and Moderna vaccines as well as the additional difficulties associated with establishing vaccination centers in rural areas. Beyond the infrastructure itself, these measures will also require improved power supplies in several regions of the continent, a feat that many nations have struggled with long before the pandemic. Given these challenges, the World Health Organization (WHO) has declared that Sub-Saharan Africa is "far-from ready" to launch what would need to be one of the largest vaccination campaigns ever seen. Furthermore, these COVID-19 vaccination efforts may only be able to achieve herd immunity thresholds by 2022-2023 in this region.
Moreover, this delay represents a significant issue for the international community. If COVID-19 continues to fester in even a single region, this area will serve as a "reservoir" for the virus from which it can continue to travel globally and cause repeated outbreaks. In turn, that will cause substantial disruptions to international commerce, communication, and trade, further hampering the economic recovery prospects of an already devastating global recession.
Similarly, the longer the virus is left to circulate, the likelier it is to mutate. As we have seen with the immense international concern surrounding the variants of COVID-19 first emerging in the UK and Brazil, such mutations could adversely affect the efficacy of treatment and prevention efforts. While both the Moderna and Pfizer vaccines do appear to be effective against variant strains, a South African strain may spread faster and limit the efficacy of any existing treatment. If allowed to spread unchecked throughout Sub-Saharan Africa, the international community runs the risk of seeing reinfections and the origination of more advanced mutant strains, which could greatly hamper viral containment efforts worldwide.
Faced with these risks for the international community, countries around the world must take steps to improve vaccine supplies in Africa. Some states, like China and Russia, have already begun to act, using a series of "vaccine diplomacy" deals to give or sell the vaccine to Sub-Saharan states. However, many questions have been raised about whether this vaccine diplomacy is indeed reliable, and many have noted limited follow-through on the part of the Russian and Chinese governments.
Meanwhile, the global vaccine-sharing project COVAX has been more successful, indicating that their delivery process may begin in early 2021, and with the first doses already arriving in West Africa. However, as many governments have noted, COVAX may need to be supplemented with other vaccines in order to ensure that these countries can reach herd immunity thresholds. Moreover, many of the distribution challenges have not yet been clearly resolved, which pose an important dilemma even if sufficient doses are delivered.
Therefore, it is essential that the rest of the world, including many states beyond Sub-Saharan Africa, take several steps to prevent a large-scale health crisis. First, high-income states should strive to finish vaccination efforts as quickly as possible and transfer any remaining doses to COVAX for distribution in Sub-Saharan Africa. Given the improbability that nations with vaccines would give them up now, it is more pragmatic to have vaccine-rich states work on rapidly completing vaccinations, so that the global vaccine supply chain's focus can move to other regions.
Second, the WHO and other international and regional actors, as well as various governments, must invest and develop the energy production and storage facilities needed for vaccine storage and distribution. Even temporary facilities to generate the power needed for cold vaccine storage may go a long way in helping ensure the vaccine gets to the populations who need it. Additionally, alongside regional states, the WHO and other international and regional actors need to engage in collective bargaining to reserve more doses, especially for future orders from Pfizer/BioNTech, Moderna, and AstraZeneca. Group efforts will improve these states' likelihood of securing the vaccine, an investment well worth some diplomatic coordination.
Finally, high-income countries should increase financial and material support to COVAX, WHO Africa, and other regional governments in order to prevent a large-scale regional or potentially global viral resurgence. While several governments, such as the Biden administration in the United States, have increased their funding for these groups, greater efforts are needed to truly make a more meaningful impact. The funding should be clearly delineated for setting up distribution efforts and should be overseen by transparent actors to ensure funds are used in a timely and effective manner.
With these efforts, Sub-Saharan Africa may be able to speed up the pace of vaccination, an effort that will save thousands of lives and prevent even more economic devastation. Such measures could serve as an important turning point, heralding the beginning of the end for the pandemic in this region. Moreover, if these efforts are implemented successfully, these plans might serve to develop much-needed fundamental healthcare infrastructure, upon which future vaccination efforts can be built. However, achieving this more optimistic future will not be easy. It will require immense coordination, cooperation, and trust among numerous regional and international actors to ensure that we are not just able to beat one health crisis, but that we can also prevent another.